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Molecular epidemiology of Mu ltidrug resistant Extended-Spectrum β -Lactamase Producing Klebsie lla pneumoniae outbreak in a neonatal intensive care unit

Background: Extended spectrum beta lactamase (ESBL)-producing Klebsiella pneumoniae have been occasionally reported as a cause of septicemia outbreak among pediatric patients in medical literature. We aimed to study the source of an outbreak of ESBL-producing K. pneumoniae in the Neonatal Intensive care Unit (NICU) at a tertiary care hospital in South India.

Methods: The outbreak was investigated by phenotypically typing the isolates followed by random amplified polymorphic DNA analysis (RAPD). A total of 31 K. pneumoniae, consisting of 27 blood isolates from neonates and 4 environmental isolates were studied. Antibiotic susceptibility patterns were determined using standard disc diffusion methods; ESBL production was tested both phenotypically and genotypically. The strains were typed using two primers AP4 and HLWL74.

Results: Except 2 environmental strains, all were found to be ESBL producers and of ESBL types TEM-1, SHV-12 and CTX-M- 15. Two different antibiotic resistance patterns were identified and the RAPD typing revealed two profiles. Phenotypic and genotypic analyses showed that 2 environmental strains had been responsible for the outbreak.

Conclusion: Safe clinical practices should be followed in neonatal wards to prevent spread of infection. This is the first report of blaCTX-M-15 producing K.pneumoniae and the first outbreak in our hospital due to CTX-M-15 producing K.pneumoniae.


Parveen R Mohamudha, Acharya N Srinivas, Dhodapkar Rahul, B N Harish, S C Parija

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